A while back, I packed my gym gear, clothes, and my laptop to go stay with family and friends in NorCal for a month. Because my telemedicine work is done over the internet, I can earn a living from just about anywhere. Similarly, I was able to earn a good living during my last extended stay overseas in Barcelona.
An extended stay overseas is different from taking a brief vacation. The latter can be managed by spending extra money to handle logistics. You can roam internationally with your cell phone, take along extra cash, accept ridiculous currency exchange rates on your credit card, and get around by taxi or Uber.
In this post I’ll talk about what I have learned from my previous trip and how to overcome common barriers with an extended overseas stay for expats. In future posts I’ll talk about ways a physician can earn money while overseas.
The Digital Nomad World
Those of us who work in healthcare may not be familiar with the massive globalization movement that’s underway. US companies hire employees from India. Chinese companies hire employees from the US. Work visas are issued readily for these digital nomads to help run the technological infrastructure of the world.
In fact, Teladoc just purchased the largest international virtual medicine provider for a little under $400M. Imagine opening the US healthcare market to international patients.
Because of telecommuting plenty of individuals have been traveling the world and staying for several months at a time in a new destination. They are called digital nomads.
A computer programming, network administration, project management, and consulting work can be done through a digital connection. Medicine is different. Each country and each local district has their own rules. This is why a California physician cannot prescribe medication to a California resident while that patient is traveling through Texas.
Telemedicine
Can you practice telemedicine as a US physician while you live in another country?
There is no aw against this but each telemedicine company has their own policy. Currently, only 2 telemedicine companies allow their physicians to do telemedicine work from another country.
Choosing a Destination
Europe is a good place to start because most cities will have solid infrastructure. It’s easy to get a cell phone, an ID, use public transportation, and racism and sexism is minimal.
Most of us will choose a destination based on something that draws us overseas. Perhaps you want to learn French, have always wanted to experience the culture in Taiwan, or live the slow-paced lifestyle of Greece.
Others may choose a destination based on their own heritage or desire for dual residencies. But it’s worthwhile considering the cost of living.
Cost of Living
In the US, it’s assumed that you’ll always pay a ton for labor. In other countries, labor is cheap, it’s the imported products/parts which will set you back.
You can live in a Thailand on the cheap especially due to currency exchange rates. You can enjoy amazing food, lounge on great beaches, and trek out to the countryside. If your needs are basic then you can live a luxurious lifestyle for far less than in the US.
In a country like Spain, jobs aren’t abundant. Labor is cheap and bureaucracy curbs innovation which stunts the economy. Real estate, whether rent or purchase, isn’t particular expensive. With inexpensive healthcare and a solid public transportation grid, it’s a unique cost saving opportunity for the adventurous medical professional.
Language Barrier
Learning a new language is the fun part of an extended stay overseas. It’s not an easy challenge to overcome but fun, nevertheless.
Vietnam and Spain are two examples where you’ll be fully immersed in the foreign language. I never met anyone who spoke English in Vietnam and met only one person in the library who spoke English in Spain.
Google Translate can get you by. It won’t be perfect but making the effort will usually inspire others to do the same in a conversation.
Beaurocracy
If you don’t speak English and try to settle down in the US, you’ll find that our customer service driven culture will make every effort to communicate with you.
In other countries, few people in government roles will make the effort to communicate with you if you don’t speak English. This makes it hard when you’re applying for a visa or a government ID, or a foreign bank account.
Hiring a lawyer or a bilingual professional who can help you with legal or logistical matters is a worthwhile expenditure. It shouldn’t be a crutch but a way to get you by in the short-term.
Banking
You might need a government ID and a residency card before you can open a bank account overseas. Some banks are geared more towards expats but may not be better banks.
Banking laws are strict so the same bank you have in the US won’t have anything to do with its equivalent overseas. You might have ING Direct in the US but you won’t be able to use the same bank in Spain.
Banking & Residency Status
If you pay with your US bank card too many times overseas then your bank could become suspicious. They might assume that you are no longer a resident of the US and will close your bank account.
This happens enough times that people have figured out ways around this by keeping their US banks in the dark regarding their location.
Some have circumvented this problem by opening a more international-friendly checking account such as Charles Schwab’s.
You will still need a US based mailing address for your US account. What most individuals do is use a friend’s or family member’s address. It works out fine.
PayPal
Don’t forget about PayPal. It’s a really easy way for you to get paid and to transfer money between various accounts.
You can get paid to your US bank account and then transfer that money to PayPal. You may then need a foreign PayPal account so that you can transfer the money from one to another.
However, if you are logging into your US PayPal account excessively from overseas then they might close your account as well. I recommend using a VPN to mask your location as I’ll discuss in a little bit.
Postal Mail
Handling US physical mail is another problem that the overseas traveler must address. Furthermore, in order to retain your residency in the US, you will need to have a physical US address.
The easiest thing is to find a good friend who will let you use their mailing address. Ideally this person is responsible enough that they won’t misplace important letters and can on occasion forward physical mail to you overseas.
A Friend’s Address
I recommend against letting any US-based company know that you are going to stay overseas for an extended period of time. This will surely create headaches for you. Therefore, do not give them an overseas mail forwarding address.
Instead use a friend’s or family’s address as I mentioned above. Alternatively, you can use a mail service which is geared towards long-term travelers.
Mail Service
There are many mail service companies such as Traveling Mailbox which can receive your mail, scan it for you to view, and forward it if necessary.
Even better, they can offer you a physical mailing address in order to keep everything legitimate. All the banks care about is that you have a physical US address. As for legal matters regarding residency, I recommend reviewing the laws yourself to avoid trouble in the future.
Prices for such mail services range from $15-$70/month. This is dictated by how much mail you receive and how many pages have to be scanned.
Internet/Communication
Cell phones and internet are a lot more advanced overseas. You shouldn’t have any trouble using a prepaid plan for mobile data and use your cell phone as a hotspot.
I have successfully used my unlocked iPhone 7 in Spain by purchasing a local SIM card from Vodafone. Both the reception and ease of using my cell phone as a hotspot were satisfactory.
Cell phone coverage is quite good in most major cities and data is inexpensive. In Europe it’s easy to get 1GB of data for 10 Euro per month.
Of course this will vary from provider to provider. It’s best to ask others on expat websites or on country-specific websites such as Reddit-Spain to get a better idea.
Mobile Data
With Google Hangouts and Skype I have no need for texting or a phone plan. All I need is a data plan and I can send text messages and complete VoIP calls. WhatsApp is also popular overseas.
A prepaid SIM card can be purchased online or from local stores and you just swap out your US SIM for the foreign SIM. It’s good to ensure that your phone is compatible with the local cell services.
If you don’t do a lot of streaming media such as Netflix or YouTube then you might be able to skip your home internet altogether and just use your phone’s data plan.
Even when doing telemedicine, I was able to get by on 1-2GB per month when I was living in Spain.
Security/Privacy
When I visit my banking website I don’t want them to know that I’m logging in from another country. In fact, the same is true for any website. I don’t sign petitions on the street, I don’t give out my phone number to strangers, and I don’t answer phone calls from unknown numbers.
My data and my privacy is protected. I have the right to decide whom I share it with.
In short, I put a lot of effort into protecting my privacy. Nobody but me needs to know which websites I’m visiting and from what locations.
Using a VPN Service
I have a VPN installed on my laptop which protects all the digital data coming into and leaving my laptop.
The VPN also allows me to control my broadcasted location by choosing a unique IP address. The IP address is the same as the caller ID on a cell phone. If someone calls you with an area code of 310 then you could assume that the person is calling from LA.
However, anyone can get a cell phone number with an area code from any part of the US. The same is true for an IP address. I can use a VPN to mask my location and show the location that I want websites to think I’m connecting from.
I will write more how to use a VPN client as a software on your laptop and installed on your router for ultimate privacy and security.
Housing
Airbnb is a good way to start your search for housing overseas. Since it’s widely adopted by Americans, it’s likely that the person who is listing their unit on Airbnb or similar websites will speak some English.
If you are planning an extended stay then I don’t recommend starting off with a long-term lease right away. I recommend getting a 1-3 month rental through Airbnb so that you can explore your new destination and get a better idea about prices and tenancy regulations.
Maybe you have no desire to settle down in one location and want to move around. Perfect. Short-term rentals are ideal for this.
By renting for at least 30 days you will also circumvent a lot of local laws which aim to restrict short-term rentals. On the flip side, by renting for more than one month, you may also have to abide by local laws which require landlords to collect personal information from you.
Be prepared to hand over photocopies of your national ID card and passport to an Airbnb host even if you are only staying for two months.
Amenities
You will pay a premium for the ease of using Airbnb. In return, you will get a fully furnished apartment or house with all utilities already connected.
In some countries you will need to be a resident or at least have a long-term visa before you can open a bank account, establish utilities, or even order home internet.
Long-term Rental
You can find your long-term rental through Airbnb but you’ll pay a premium for this. It’s better to find out which websites the locals use for their rental listings.
Craigslist is becoming more ubiquitous, try that first. After that you’ll just have to wrestle various websites and figure out the quirks for each city and country.
In Spain, for example, ideallista is the main website for finding housing. The problem is that some listings are advertised by realtors who charge high fees. This isn’t transparent until you go to sign the rental documents.
On idealista as soon as an affordable unit becomes available, the person listing it will be bombarded with emails and phone calls. Because the housing market is so competitive, it’s one of those things where you have to pounce on the deal or keep fishing.
Finally, traditional rental units will need a 12-month lease, similar to the US. This means that the unit will be unfurnished. In the US, unfurnished means that the kitchen is complete. In Spain, there won’t be a washer/dryer, no fridge, no microwave, and often no stove.
Transportation
I suggest choosing a destination with good public transportation. Consider renting or buying a bicycle. Car sharing services and carpool apps are abundant in most other countries. Example in Spain are BlaBlaCar and BlueMove.
Uber can be found in many countries as well. Even if it’s a bit costly to use at first, it will help you get to know your neighborhood. Eventually you’ll figure out how to take advantage of cheaper options such as a bus or a car sharing service.
If you are used to Uber and it doesn’t exist in your destination of choice, consider looking into other taxi apps such as MyTaxi which closely emulate Uber.
Income/Work
I’ve discussed the various telemedicine companies which will allow you to do patient care while overseas. This is a good way to earn some travel money during your extended stay abroad.
Hopefully you can mix in some consulting work or enjoy some passive income from your investments.
Work Laws
If you don’t have a work visa then you cannot be employed while overseas. However, you are allowed to earn an income as long as your customers aren’t local customers.
I obtained my non-lucrative visa for Spain which doesn’t include a work permit. However, I am allowed to earn income from US sources and get paid by US employers.
Teaching
Teaching opportunities aren’t hard to come by. But you often need a connection since they are sought after. Teaching English is just one such income source.
An employer overseas can sponsor you to get a work visa. The process isn’t too hard and if it’s a large enough employer, they can manage most of the paperwork for you. Physicians from the US are employed in other countries such as New Zealand, Australia, and Canada through such sponsorships.
A a medical professional you might also have teaching opportunities or consulting opportunities overseas. LinkedIn has such job listings once you figure out the proper search terms to use.
Getting Help
I am willing to spend good money on a lawyer or a financial adviser. I would rather earn the money needed to pay the experts than have to figure out all the nuances myself.
Once overseas, you can hire local lawyers or experts who cater to expats. These individuals will help you navigate the local laws, they’ll offer translation services, and save you money in the long-run.
A good example is this company who helps English speakers get their NIE which is the Spanish equivalent of a social security card. The process is complicated and time-consuming – these guys make it really easy, for cheap.
Expat Websites
You have to be careful when using expat websites because they are heavily biased towards their advertisers. Some of their recommendations are simply ad placements and will be disappointing.
Reddit can be a good source. You can search for the country or city and post questions you might have to locals.
Researching Cities
I like nomadlist as a source to research your new destination. Especially if you are planning on working while at your new overseas destination, it helps to check out nomadlist.
Hobby/Interest Forums
If you have a certain hobby or interest, maybe music or automotive, consider posting on your forum to see if anyone has any good connections in your destination city.
This has worked for me both internationally and in the US. As an added bonus, the person you connect with will also share your interests.